Alpha1-Antitrypsin Deficiency

A 60-year-old white man presents for evaluation of progressive dyspnea. He is a former smoker with a 20-pack-year smoking history and a 10-year history of diagnosed chronic obstructive pulmonary disease (COPD). There is no family history of COPD. Severe airflow obstruction is seen on spirometry, with a forced expiratory volume in 1 second (FEV1) that is 40% of the predicted value. Should the patient be evaluated for alpha(1)-antitrypsin (AAT) deficiency? If AAT deficiency is documented, how should his case be managed?